Local circumstances determine how scientific evidence is translated into medical practice, asserted John M. Eisenberg, M.D., M.B.A., former director of the Agency for Healthcare Research and Quality, in a recent commentary that was published posthumously (Dr. Eisenberg died March 10, 2002). For example, the U.S. Preventive Services Task Force, which examined evidence on colon cancer, decided to issue screening recommendations. However, members of a similar New Zealand group looked at the same scientific research and concluded that harm could result from the many false positives resulting from such screening.
Opportunities have recently emerged to share evidence globally about the outcomes and effectiveness of health care (globalization) and then translate that evidence into improved health care at the local level (localization). To succeed in globalizing the evidence, policymakers must realize that opportunities to do so will be tempered by three competing core values: choice, efficiency, and equity.
In the United States and many Western nations, the ability to choose based on one's own preferences is paramount, even in the face of evidence showing less favorable outcomes with the treatment chosen. In other nations, finding the best way to use scarce resources—that is, efficiency—will control how research is translated into practice. In still other countries, devoting resources toward those with the greatest unmet needs, or equity, will dictate how evidence is used.
In the commentary, Dr. Eisenberg suggested that policymakers recognize and, perhaps celebrate, the fact that variations in clinical practice are inevitable. A multitude of factors—such as national character, affordability of care, access to information, parochialism, and the legal environment—influence the translation of research into practice. He advocated strengthening the local use of available evidence with better access to evidence-based medicine, professional commitment to translating evidence into practice, and a practice philosophy that embraces shared decisionmaking.
More details are in "Globalize the evidence, localize the decision: Evidence-based medicine and international diversity," by Dr. Eisenberg, in the May 2002 Health Affairs 21(3), pp. 166-168.
Reprints (AHRQ Publication No. 02-R066) are available from the AHRQ Publications Clearinghouse and AHRQ InstantFax.